respiratory distress

[sfry]

Hi,

I need your expert option. I was an EMT years ago. But now work in the billing office submitting ambulance claims to Medicare. Allot of coding people, prior to my arrival, code any sign of breathing difficultly as Acute Respiratory Distress (ARD). This includes SOB and Resp Distress. I want to have a training session with them but I having difficultly locating signs and symptoms for SOB, ARD, and Resp. Distress over the web. Can you help?

 

[bikenburn]

My question for you is how many codes are there that you could use to differentiate your medical problems? Does your system allow for differentiation of asthma vs emphysema vs bronchitis or does it group all of them under their functional group of COPD's? The problem it sounds like your people are having is that first off, SOB is a symptom secondary to a primary problem. While SOB may be due to a respiratory illness, it could also be due to an AMI, heart failure, anaphylaxis (to name a few.)
My understanding thus far is that ARDS or ARF is essentially an inability of the reparatory system to provide adequate O2 to the blood. This again could be due to several factors, and depending on how the coding is trying to differentiate, it could be very different. I'll see if I can find anything on the web for you about S/S's of the varying illnesses.

 

[sfry]

Thanks for your response. I agree that primary conditions like asthma, emphysema and bronchitis explain why they maybe having breathing difficulty. However, sometimes the run sheets only indicate a history of the above or they are absent altogether from the report.

For example, the call is dispatched as "breathing problems". Crew arrives to find pt sitting in chair and complaining of SOB that began an hour ago. Pt history is renal failure and HTN. Current vitals are HR 74/ B.P 170/100 and Resp 22. Breathing effort is Fatigued. Pt placed on O2 @ 15 LPM via NRB.

Another example: same as above except Resp is 16, breathing effort is normal and pt was placed on 02 @ 1 LPM via NRB.

Is it possible to draw hints from the RESP / Breathing EFFORT and LPM of 02? If so, what would be the range? For example, if we know normal breathing is 12-20 bpm for adults, what range would be considered resp distress versus ARD?

 

[Epi-do]

pt was placed on 02 @ 1 LPM via NRB

Ok, I can't help you out with your billing question, but surely this is a typo. Is it supposed to be either "via NC" or maybe 10/12/15 LPM? I just don't know anyone that would use a NRB with only 1 LPM.

 

[DT4EMS]

Hi,

I need your expert option. I was an EMT years ago. But now work in the billing office submitting ambulance claims to Medicare. Allot of coding people, prior to my arrival, code any sign of breathing difficultly as Acute Respiratory Distress (ARD). This includes SOB and Resp Distress. I want to have a training session with them but I having difficultly locating signs and symptoms for SOB, ARD, and Resp. Distress over the web. Can you help?

The main reason is the way medicare pays for the "billing". We started making sure SOB was no longer used in the narative because of the way Medicare payed for it.

SOB may be confused for the way the person "acted"...... pun intended.

Some others may still chime in, but I believe the way the "complaint" is listed will help with your billing problem.

 

[Jon]

My concern is that the assement of breathing difficulty is subjective, as is the amount of O2 EMS places a patient on... I've seen some EMT's who NEVER use oxygen, and I've seen some that give it to almost every patient.

I've not worked in billing/coding... so I don't know what could help you... i'd just reccomend against O2 as the sole guide.

 

[islandgal]

Hi,

I need your expert option. I was an EMT years ago. But now work in the billing office submitting ambulance claims to Medicare. Allot of coding people, prior to my arrival, code any sign of breathing difficultly as Acute Respiratory Distress (ARD). This includes SOB and Resp Distress. I want to have a training session with them but I having difficultly locating signs and symptoms for SOB, ARD, and Resp. Distress over the web. Can you help?

The joy of working with medicare. There are certain dx they will accept. The fact you are working off run sheets that most likely do not have a dx (not ems's job) and hippa regulations making it hard to get info from the hospitals is a tough spot. It makes it even more critical your medics/emts get a good history. You can site COPD, CHF, etc, as a primary dx and support it by SOB or whatever symptoms were present prompting that call. No way an expert, JMO.
Good luck